NPI Details
REVITALIZE MEDICAL SUPPLY is a clinical medical laboratory in Idaho Falls, ID. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. REVITALIZE MEDICAL SUPPLY NPI is 1508533209. The provider is registered as an organization entity type.
The provider Is Doing Business As Healix Diagnostics.
The provider's business location address is:
1680 ELK CREEK DR # 2
IDAHO FALLS, ID
ZIP 83404-225
Phone: (208) 757-4325
The provider's authorized official is Whitney Whitworth .
The authorized official title is Owner and has the following contact phone number (208) 589-0821.
The CLIA number assigned to this NPI record is 13D2315547 - independent with a certificate type of Certificate of Compliance.
The enumeration date for this NPI number is 8/30/2021 and was last updated on 1/17/2025.
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 291U00000X | Clinical Medical Laboratory | | | | Yes |
